A Regulatory Response to Healthcare Serial Killing

Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing

The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.

Brave Clarice-healthcare serial killers, patterns, motives, and solutions

Healthcare serial killing involves the intentional killing of multiple patients by a healthcare professional. It is a formidable challenge to identify in the medical context, and a daunting legal task to prove beyond reasonable doubt. What can be done or remains to be done to intercept these serial killing events and help serve justice, while at the same time not risk dismantling public trust in the healthcare system? In light of several recent modern charges of murder against healthcare practitioners across the world, this review aims to report the themes, patterns, and motives of medical serial killers as well as highlight areas of work on both medical and legal fronts to help identify these events, and to most importantly protect the vulnerable patient community.

Serial murder in medical clinics and care homes

BACKGROUND

Serial murder in clinics and care homes have gained attention more than once in recent years. The strong yet quickly fading public outrage has not yet led to well-founded professional and health-political engagement with the topic. With few systematic studies conducted, knowledge about perpetrator-related and environment-related risk factors in the day-to-day context of healthcare is sparse.

METHODS

Court cases of serial murder in clinics and care homes in Germany, Austria, and Switzerland that were concluded with a final verdict by February 2022 were investigated. Research materials consisted of court documents and observations made during the trials. The cases were evaluated with regard to the victims, crime scenes, methods of killing, perpetrators, and perpetrator motives. 12 serial murders involving 17 perpetrators were included in this study.

RESULTS

Perpetrator-specific early warning signs included a pronounced insecurity in combination with a striving for prestige and power, which were accompanied by a loss of empathy. Reactions of the colleagues and supervisors of the perpetrators in the immediate professional environment included misjudgement, concern about one's own disadvantages, feared damage to the reputation of the institution, and insufficient willingness to clarify the situation. As a result, many initial murders went unsuspected and unreported so that the frequency of the criminal activity and the number of victims increased over time.

CONCLUSION

More information about serial murder in clinics and care homes is necessary. Research efforts are needed to better assess the prevalence of such crimes and to develop appropriate preventive measures. Circumstances that enable such acts, risk factors, perpetrator profiles, and early-stage countermeasures must be comprehensively addressed in the context of education, training and further education.